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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3677_Библиотеки_им_академика_М_И_Перельмана
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2.7 Recommendations forPediatric TEE
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2.7 Recommendations forPediatric TEE (Refer toTable 2.2)
Due to the unique anatomy of infants and children, including a smaller diameter of
the esophagus and a reduced safety margin, special considerations must be made
when using TEE in pediatric patients. These recommendations are outlined in
Table2.2.
Table 2.2 Recommendations of TEE in pediatric patients
Required basic knowledge and skills of TEE
Monitoring of vital signs during the procedure
Avoid TEE probe-associated injury
Avoid forceful placement
Avoid the probe inlocked position
Generous lubrication
Removal of nasogastric tube or feeding tube
Temporary removal of TEE probe during the long duration of CPB
Routine check the blood stains over the TEE probe when the probe was removed to ensure
without trauma by TEE probe
Awareness of pathophysiology of CHD
Prevention of cardiovascular and respiratory effects during the TEE probe placement
TEE can be used safely after sternotomy in child with TAPVC (total anomalous pulmonary
venous connection)
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2 Transesophageal Echocardiography (TEE) forPediatric Congenital Cardiac Surgery…
2.8 Conclusion
During surgical procedures or catheter-based treatments for CHD, accurate identication of cardiac morphological features is essential to make informed decisions
and increase the likelihood of success. TEE is a useful tool for guiding decisions in
pediatric cardiology, but it is a semi-invasive procedure that requires additional caution when used in children compared to adults. When performing TEE in pediatric
patients, it is important to use endotracheal anesthesia and continuously monitor
vital signs to ensure their safety. The procedure should involve a team of specialists,
including pediatric cardiologists, cardiac surgeons, radiologists, and anesthesiologists. Figure2.15 illustrates the importance of a teamwork in this process. If there
are any difculties with inserting the TEE probe or if the patient experiences systemic hypotension or desaturation, it is crucial to immediately stop the procedure
and withdraw the probe. This step is essential to ensure the safety of the pediatric
patients. In summary, TEE is a valuable tool for guiding decisions during surgical
repair or interventional therapy in pediatric cardiology, but extra caution and a team
approach are necessary when performing the procedure in children.
Fig. 2.15 Shows the pediatric intervention procedure that was carried out in the hybrid room.
Crucial collaboration and effective communication among the staff are important in ensuring the
successful completion of the operation and maintaining the safety of the patient
References
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References
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stenosis. Front Pediatr. 2022;10:822271.
13. Haase FR, Brenner A.Esophageal diameter at various ages. Arch Otolaryngol. 1963;77:119–22.
14. Thomas SB, Thekla VK, Alexander S, Oliver HD.Esophageal diameter in children correlated
to body weight. Eur J Pediatr Surg. 2019;29:528–32.
15. Tsai SK.The role of transesophageal echocardiography in clinical use. J Chin Med Assoc.
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16. Tsai SK, Chang CI, Wang MJ, Chen SJ, Chiu IS, etal. The assessment of the proximal left pulmonary artery by transesophageal echocardiography and computed tomography in neonates
and infants: a case series. Analgesia. 2001;93:594–7.
17. Lennon MJ, Gibbs NM, Weightman WM, Ee HC.Transesophageal echocardiography-related
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18. Nana AM, Stefanidis C, Chami JP, Deviere J, Barvais L, etal. Esophageal perforation during
cardiac surgery: treatment by endoscopic stenting. Ann Thorac Surg. 2003;75:1955–7.
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Part II
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TEE Monitoring of Pediatric Congenital
Cardiac Surgery
The chapters of this part focus on the use of transesophageal echocardiography
(TEE) for monitoring pediatric patients undergoing surgery for congenital heart
diseases.
Septal Defects
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3.1 Atrial Septal Defect (ASD)
Atrial septal defect (ASD) is a congenital heart defect characterized by an abnormal
opening in the wall (septum) between the two upper chambers (atria) of the heart.
There are several types of ASDs, including [1, 2]: (as depicted in Fig.3.1)
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Fig. 3.1 Describes the types of atrial septal defect (ASD) based on their location as seen in a 3D
TEE image (a) and a 3D cardiac CT image (b). The most common type is ostium secundum (1),
located in the area of the fossa ovalis. Ostium primum (2), which affects 10–15% of cases, is
located in the lower part of the atrial septum and overlies the mitral and tricuspid valves. Superior
sinus venous (3) and inferior sinus venous (4), each affecting 5% of cases, are located in the upper
and lower parts of the dorsal interatrial septum near the entry of the superior and inferior vena cava,
respectively. The rarest type, coronary sinus septal defect (5), occurs in less than 1% of cases and
is located between the coronary sinus roof and the left atrium oor
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
S.-K. Tsai et al., Transesophageal Echocardiography in Pediatric Congenital Cardiac
Surgery and Catheter Intervention, https://doi.org/10.1007/978-981-99-6582-3_3
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3 Septal Defects
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d
Fig. 3.2 Illustrates a surgical repair of an ostium primum atrial septal defect (ASD) in a 4-yearold boy. The preoperative TEE in ME four-chamber view (a) shows the defect (yellow dotted line)
in the inferior part of the interatrial septum. After the repair (b), the postoperative TEE in ME
four-chamber view shows the surgical patch without any residual shunt. Furthermore, an incompletely formed septum primum is associated with an anterior mitral leaet cleft and mitral regurgitation, which can be observed in the four-chamber view (c). Additionally, subaortic stenosis can be
identied in the ME AV LAX view (d). More details regarding this topic will be covered in
Fig. 3.18
1. Primum ASD (as shown in Fig.3.2): This type of ASD occurs at the lower part
of the interatrial septum, near the tricuspid and mitral valves. It is often associated with other congenital heart defects, such as a cleft in the mitral or tricuspid valve.
2. Secundum ASD (as shown in Fig.3.3): This is the most common type of ASD,
accounting for about 70% of all cases. It occurs in the central of the interatrial
septum and is often small to moderate in size.
3. Sinus venosus ASD (Figs.3.4 and 3.5): This unusual type of ASD is located near
the superior vena cava or inferior vena cava. These veins are responsible for carrying blood from the upper and lower parts of the body respectively, and this
3.1 Atrial Septal Defect (ASD)
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b
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Fig. 3.3 A child with secundum atrial septal defect underwent surgical repair. (a) Preoperative
TEE in the ME AV SAX view showing an ostium secundum defect with dilated RA (left diagram).
Color Doppler ow image demonstrates a left to right shunt ow (arrow in right diagram). (b)
Postoperative TEE in the same patient showing successful patch repair without any residual shunt
(right diagram)
condition usually generally associated with an anomalous pulmonary venous
connection. It accounts for about 5–10% of all ASD cases.
4. Unroofed coronary sinus ASD (as shown in Figs.3.6, 3.7, and 3.8): This rare
type of ASD (less than 1% of all ASD) occurs when there is a defect (complete
or incomplete) on the wall between the coronary sinus and the left atrium, and it
can occur with persistent left SVC.The complete form is also known as totally
unroofed coronary sinus ASD (as shown in Fig.3.7).
The symptoms of ASD vary depending on the size of the defect and the age of
the individual. Small ASDs may not cause any symptoms and may close spontaneously during infancy. Larger ASDs can cause serious complications such as
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3 Septal Defects
c
d
Fig. 3.4 Shows the surgical repair of a superior sinus venous atrial septal defect (SVASD) in a
6-year-old boy. A schematic drawing in (a) illustrates the superior SVASD (green circle) located
above the superior vena cava (SVC), as viewed from the unroofed right atrium. The preoperative
oblique sagittal contrast-enhanced cardiac CT (b) shows the SVC draining to the left atrium (LA)
through the defect (red dotted line). The preoperative TEE bicaval view (c) demonstrates the discontinuity of the SVC-IAS (interatrial septum) junction (yellow dotted line), resulting in blood
ow from the SVC into both the right and left atria and partial anomaly of pulmonary venous
drainages into the right atrium. The postoperative TEE bicaval view (d) shows the successful repair
of the defect between the SVC-IAS with a patch
3.1 Atrial Septal Defect (ASD)
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a b
d
Fig. 3.5 Shows the surgical repair of an inferior sinus venous atrial septal defect (SVASD) associated with anomalous pulmonary venous drainage in a 3-year-girl. A schematic drawing in (a)
highlights the sinus venosus defect (green circle) of the inferior vena cava (IVC) viewed from the
unroofed right atrium. The preoperative cardiac CT in a four-chamber thin-slab MIP image (b)
shows an inferior SVASD (arrow) with a right lower pulmonary vein (RLPV) draining into the
right atrium (RA) and a dilated RA.Intraoperative photo taken after the right atrial incision (c)
displays a large atrial septal defect (ASD) measuring 1.5cm and the drainage of the RLPV into the
RA, as indicated by the inserted suction tube. The preoperative TEE with color Doppler bicaval
view (d) reveals a dilated right atrium (RA) and a discontinuity in the inferior vena cava-interatrial
septum (IVC-IAS) junction. This defect could allow the ow from the RLPV returns into the RA
(right diagram). The postoperative TEE bicaval view (e) displays the bafe rerouting of the partially anomalous venous connection to the LA and ASD repair, indicated by the small yellow
arrows in the left diagram. The color Doppler image shows the blood owing from the IVC into
the RA and the RLPV into LA, without any shunt crossing the patch (right diagram)
e
c
right-sided heart failure, arrhythmias, stroke, early death or pulmonary hypertension. Larger ones may require percutaneous repair (will be discussed in Sect. 8.3) or
surgical repair [3, 4] under the TEE monitoring (see Figs.3.2, 3.3, 3.4, 3.5, 3.6, 3.7,
3.8, 3.9, and 3.10).
Соседние файлы в папке Библиотека им академика М.И. Перельмана